Disease outcome in T1 glottic carcinoma
Sjögren, E.V.
Citation
Sjögren, E. V. (2009, December 10). Disease outcome in T1 glottic carcinoma. Retrieved from https://hdl.handle.net/1887/14552
Version: Corrected Publisher’s Version
License: Licence agreement concerning inclusion of doctoral thesis in the Institutional Repository of the University of Leiden
Downloaded from: https://hdl.handle.net/1887/14552
Note: To cite this publication please use the final published version (if
applicable).
"QQFOEJDFT
*4BNQMFTJ[FDBMDVMBUJPOT
**&-4DMBTTJ¾DBUJPOGPSMBTFSDPSEFDUPNZ
***-BSZOYTVSWFZ
*7 -BTFSDPSEFDUPNZGPSFYUFOEFE5 1 MFTJPOT
BSFWJFXPGUIFMJUFSBUVSF
"QQFOEJDFT
"QQFOEJY
4BNQMF4J[F$BMDVMBUJPOTGPSSBOEPNJ[FE5USJBMMBTFSWFSTVTSBEJPUIFSBQZ
(FOFSBMBTTVNQUJPOT
5HMPUUJDDBSDJOPNBTQFSZFBSJOUIF/FUIFSMBOET TFFDIBQUFS
FTUJNBUFEBDDSVBM NPEFSBUFFTUJNBUF FTUJNBUFEBDDSVBMQFSZFBSY
4UBUJTUJDBMBTTVNQUJPOTPGTBNQMFTJ[FDBMDVMBUJPOT UZQF*FSSPSB
UZQF**FSSPSC QPXFS
QSJNBSZPVUDPNFMPDBMDPOUSPMPSMBSZOYQSFTFSWBUJPOBUZFBST MJLFMZFGGFDUTJ[FEJGGFSFODFT MPDBMDPOUSPM MBSZOYQSFTFSWBUJPO
$BMDVMBUJPOPGTBNQMFTJ[FDPNQBSJOHUXPQSPQPSUJPOTJOJOEFQFOEFOUHSPVQT Q QSPQPTFETJ[FPGFGGFDUJOSBEJPUIFSBQZ
Q QSPQPTFETJ[FPGFGGFDUJOMBTFS QBW Q Q
TE TUBOEBSEJ[FEEJGGFSFODFQQQBW QBW TBNQMFTJ[F TE
-PDBMDPOUSPM
TE £Y¥
TBNQMFTJ[F ¥
-BSZOYQSFTFSWBUJPO
TE Y¥
TBNQMFTJ[F ¥
1FUSJFBOE4BCJO.FEJDBM4UBUJTUJDTBUB(MBODF#MBDLXFMM4DJFODF-UEQQ
3FTVMU
4BNQMF TJ[F OFFEFE GPS B EJGGFSFODF JO MPDBM DPOUSPM GSPN UP BU TJH
OJ¾DBODF MFWFM BOE QPXFS QFS BSN 5IF BDDSVBM JO B OBUJPOXJEF USJBM XJUI
MPDBMDPOUSPMBTQSJNBSZPVUDPNFXPVMEUIFSFGPSFUBLFZFBSTXJUIBOPUIFSZFBSTGPS
GPMMPXVQ
4BNQMFTJ[FOFFEFEGPSBEJGGFSFODFJOMBSZOYQSFTFSWBUJPOGSPNUPBU
TJHOJ¾DBODFMFWFMBOEQPXFS QFSBSN5IFBDDSVBMJOBOBUJPOXJEFUSJBMXJUIMBS
ZOYQSFTFSWBUJPOBTQSJNBSZPVUDPNFXPVMEUIFSFGPSFUBLFZFBSTXJUIBOPUIFSZFBST
GPSGPMMPXVQ
$PODMVTJPO
#BTFEPOUIFTFBTTVNQUJPOTXFDPOTJEFSBUSJBMXJUIMPDBMDPOUSPMBTBQSJNBSZPVUDPNF
OFJUIFSSFMFWBOUOPSGFBTJCMF"USJBMXJUIMBSZOYQSFTFSWBUJPOBTQSJNBSZPVUDPNF BMUIPVHI
SFMFWBOU JTOPUDPOTJEFSFEGFBTJCMFFJUIFS
"QQFOEJY
&-4DMBTTJ¾DBUJPOGPS-BTFS$PSEFDUPNZ
$PSEFDUPNZUZQF %FTDSJQUJPO 5JTTVF3FNPWFE
* 4VCFQJUIFMJBM &QJUIFMJVNPOMZ
** 4VCMJHBNFOUBM &QJUIFMJVN 3FJOLFµTTQBDFBOE
WPDBMMJHBNFOU
*** 5SBOTNVTDVMBS &QJUIFMJVN 3FJOLFµTTQBDF WPDBM
MJHBNFOUBOEQBSUPGWPDBMJT
NVTDMF
*7 5PUBMDPSEFDUPNZ &YUFOETGSPNWPDBMQSPDFTTVQ
UPBOUFSJPSDPNNJTTVSF VQ
UPBOEXJUIPSXJUIPVUJOOFS
QFSJDIPOESJVN
7B &YUFOEFEDPSEFDUPNZ
FODPNQBTTJOHDPOUSBMBUFSBMWPDBM
GPME
5PUBMDPSEFDUPNZ BOUFSJPSQPSUJPO
DPOUSBMBUFSBMWPDBMGPMEBOE
#SPZMFµTMJHBNFOUXJUIPSXJUIPVU
QFUJPMFPGFQJHMPUUJT
7C &YUFOEFEDPSEFDUPNZ
FODPNQBTTJOHBSZUFOPJE
5PUBMDPSEFDUPNZ BOUFSJPS
DBSUJMBHFQBSUJBMMZPSUPUBMMZ
SFNPWFEBOEQSFTFSWBUJPOPG
QPTUBSZUFOPJENVDPTB
7D &YUFOEFEDPSEFDUPNZ
FODPNQBTTJOHWFOUSJDVMBSGPME
5PUBMDPSEFDUPNZ .PSHBOJ
WFOUSJDMFBOEWFOUSJDVMBSGPME
7E &YUFOEFEDPSEFDUPNZ
FODPNQBTTJOHTVCHMPUUJT
5PUBMDPSEFDUPNZ TVCHMPUUJD
UJTTVFVQUPNBYJNVNPGDN
CFMPXUIFHMPUUJT 7* BNFOENFOU &YUFOEFEDPSEFDUPNZ
FODPNQBTTJOHUIFBOUFSJPS
DPNNJTTVSF
#JMBUFSBMDPSEFDUPNZPGBOUFSJPS
QBSUPGCPUIWPDBMBOEWFOUSJDVMBS
GPMET BOE#SPZMFµTMJHBNFOUXJUI
PSXJUIPVUQFUJPMFPGFQJHMPUUJT
'SPN3FNBDMF. &DLFM)& "OUPOFMMJ" #SBTOVE $IFWBMJFS% 'SJFESJDI( 0MPGTTPO+FUBM &OEPTDPQJD
DPSEFDUPNZ"QSPQPTBMGPSBDMBTTJ¾DBUJPOCZUIF8PSLJOH$PNNJUUFF &VSPQFBO-BSZOHPMPHJDBM4PDJFUZ&VS
"SDI0UIPSIJOPMBSZOHPM °
'SPN3FNBDMF. 7BO)BWFSCFLF$ &DLFM) #SBEMFZ1 $IFWBMJFS% %KVLJD7FUBM1SPQPTBMGPSSFWJTJPOPG
UIF&VSPQFBO-BSZOHPMPHJDBM4PDJFUZDMBTTJ¾DBUJPOPGFOEPTDPQJDDPSEFDUPNJFT&VS"SDI0UPSIJOPMBSZOHPM
"QQFOEJDFT
'JHVSF ] $PSPOBMTFDUJPOUISPVHIFOEPMBSZOYEFNPOTUSBUJOHUIFQMBOFTPG
MFWFM*7SFTFDUJPOTBDDPSEJOHUPUIF&-4DMBTTJ¾DBUJPO
"QQFOEJY-BSZOYTVSWFZ
5:1&*46#&1*5)&-*"-$03&%&$50.:
Subepithelial cordectomy (midcord) Are you prepared to perform this resection?
as to disease outcome?
yes no
as to voice outcome?
yes no
are you prepared to sacrifice voice quality/function if this would mean reduced laryngectomy rates for the group as a whole?
yes no
Subepithelial cordectomy + anterior commissure
Are you prepared to perform this resection?
as to disease outcome?
yes no
as to voice outcome?
yes no
are you prepared to sacrifice voice quality/function if this would mean reduced laryngectomy rates for the group as a whole?
yes no
Subepithelial cordectomy + vocal process
Are you prepared to perform this resection?
as to disease outcome?
yes no
as to voice outcome?
yes no
are you prepared to sacrifice voice quality/function if this would mean reduced laryngectomy rates for the group as a whole?
yes no
Subepithelial cordectomy + anterior commissure + vocal process
Are you prepared to perform this resection?
as to disease outcome?
yes no
as to voice outcome?
yes no
are you prepared to sacrifice voice quality/function if this would mean reduced laryngectomy rates for the group as a whole?
yes no
"QQFOEJDFT
Subligamental cordectomy (midcord) Are you prepared to perform this resection?
as to disease outcome?
yes no
as to voice outcome?
yes no
are you prepared to sacrifice voice quality/function if this would mean reduced laryngectomy rates for the group as a whole?
yes no
Subligamental cordectomy + anterior commissure
Are you prepared to perform this resection?
as to disease outcome?
yes no
as to voice outcome?
yes no
are you prepared to sacrifice voice quality/function if this would mean reduced laryngectomy rates for the group as a whole?
yes no
Subligamental cordectomy+ vocal process
Are you prepared to perform this resection?
as to disease outcome?
yes no
as to voice outcome?
yes no
are you prepared to sacrifice voice quality/function if this would mean reduced laryngectomy rates for the group as a whole?
yes no
Subligamental cordectomy + anterior commissure + vocal process
Are you prepared to perform this resection?
as to disease outcome?
yes no
as to voice outcome?
yes no
are you prepared to sacrifice voice quality/function if this would mean reduced laryngectomy rates for the group as a whole?
yes no
5:1&**46#-*(".&/5"-$03%&$50.:
Transmuscular cordectomy (midcord)
Are you prepared to perform this resection?
as to disease outcome?
yes no
as to voice outcome?
yes no
are you prepared to sacrifice voice quality/function if this would mean reduced laryngectomy rates for the group as a whole?
yes no
Transmuscular cordectomy + anterior commissure
Are you prepared to perform this resection?
as to disease outcome?
yes no
as to voice outcome?
yes no
are you prepared to sacrifice voice quality/function if this would mean reduced laryngectomy rates for the group as a whole?
yes no
Transmuscular cordectomy + vocal process
Are you prepared to perform this resection?
as to disease outcome?
yes no
as to voice outcome?
yes no
are you prepared to sacrifice voice quality/function if this would mean reduced laryngectomy rates for the group as a whole?
yes no
Transmuscular cordectomy + anterior commissure + vocal process
Are you prepared to perform this resection?
as to disease outcome?
yes no
as to voice outcome?
yes no
are you prepared to sacrifice voice quality/function if this would mean reduced laryngectomy rates for the group as a whole?
yes no
5:1&***53"/4.64$6-"3$03%&$50.:
"QQFOEJDFT
Total cordectomy (midcord) Are you prepared to perform this resection?
as to disease outcome?
yes no
as to voice outcome?
yes no
are you prepared to sacrifice voice quality/function if this would mean reduced laryngectomy rates for the group as a whole?
yes no
Total cordectomy + anterior commissure
Are you prepared to perform this resection?
as to disease outcome?
yes no
as to voice outcome?
yes no
are you prepared to sacrifice voice quality/function if this would mean reduced laryngectomy rates for the group as a whole?
yes no
Total cordectomy + vocal process Are you prepared to perform this resection?
as to disease outcome?
yes no
as to voice outcome?
yes no
are you prepared to sacrifice voice quality/function if this would mean reduced laryngectomy rates for the group as a whole?
yes no
Total cordectomy + anterior commissure + vocal process
Are you prepared to perform this resection?
as to disease outcome?
yes no
as to voice outcome?
yes no
are you prepared to sacrifice voice quality/function if this would mean reduced laryngectomy rates for the group as a whole?
yes no
5:1&*7505"-$03%&$50.:
Extended cordectomy (supra- glottic)
Are you prepared to perform this resection?
as to disease outcome?
yes no
as to voice outcome?
yes no
are you prepared to sacrifice voice quality/function if this would mean reduced laryngectomy rates for the group as a whole?
yes no
Extended cordectomy (infra-glottic) Are you prepared to perform this resection?
as to disease outcome?
yes no
as to voice outcome?
yes no
are you prepared to sacrifice voice quality/function if this would mean reduced laryngectomy rates for the group as a whole?
yes no
Anterior Commissure Are you prepared to perform this resection?
as to disease outcome?
yes no
as to voice outcome?
yes no
are you prepared to sacrifice voice quality/function if this would mean reduced laryngectomy rates for the group as a whole?
yes no
5:1&7BOE7*&95&/%&%$03%&$50.:
"QQFOEJDFT
"QQFOEJY
-JUFSBSZSFWJFXPOFYUFOEFEMFTJPOT
8IFODPOTJEFSJOHFYUFOEJOHUIFJOEJDBUJPOGPSBOBMUFSOBUJWFUSFBUNFOUTVDIBTMBTFSTVSHFSZ
POFNVTU¾STUIBWFTPNFJEFBPGXIJDIMFTJPOTUPDPOTJEFSGPSFYUFOTJPOBOEXIBUPODPMPHJ
DBMBOEGVODUJPOBMSFTVMUTDBOCFFYQFDUFEGSPNUIFBMUFSOBUJWFUSFBUNFOU5IJTNVTUUIFOCF
DPNQBSFEUPUIFSFTVMUTPGUIFTUBOEBSEUSFBUNFOU SBEJPUIFSBQZ*OUIFDBTFPGHMPUUJDDBSDJ
OPNB CBTFEPOBDVSSFOUOBUJPOBMTVSWFZ DIBQUFS UXPUZQFTPGSFTFDUJPOTQSFTFOUUIFMPHJ
DBM²OFYUTUFQ³EFFQVOJMBUFSBMSFTFDUJPOTBOETVQFS¾DJBMCJMBUFSBMSFTFDUJPOT ¾H5IFTF
FYUFOTJPOTDPSSFTQPOEPOMZQBSUJBMMZUPUIFDVSSFOUTUBHJOHTZTUFNT 5/.BOE&-48JUIUIF
QSPQPTFEFYUFOTJPOTJONJOE DVSSFOUEBUBPOPODPMPHJDBMBOEGVODUJPOBMSFTVMUTSFMFWBOUUP
UIF QSPQPTFE FYUFOTJPOT JT TVNNBSJ[FE CFMPX 5IJT SFWJFX JNNFEJBUFMZ EFNPOTUSBUFT UIF
QSPCMFNTXJUIFYUFSOBMWBMJEJUZFODPVOUFSFEDMJOJDBMMZXIFOVTJOHUIFDVSSFOUTUBHJOHTZTUFNT
EFTDSJCFEJOUIFMBTUDIBQUFS
4VQFS¾DJBMMFTJPOTSFRVJSJOHCJMBUFSBMSFTFDUJPOBOEPSSFTFDUJPOPGUIFBOUFSJPSDPNNJTTVSF 8IFOFWBMVBUJOHUIFMJUFSBUVSFGPSUIJTUZQFPGMFTJPOUIFGPMMPXJOHDBUFHPSJFTPGMFTJPOTSFTFD
UJPOTBSFUIFNPTUBQQMJDBCMF
5B BOUFSJPSDPNNJTTVSFJOWPMWFNFOU 5C
UZQF7SFTFDUJPOT TQFDJ¾DBMMZUZQF7B
%BUB JT TVNNBSJ[FE JO UBCMF 6OGPSUVOBUFMZ BMM UIFTF DBUFHPSJFT IBWF UIFJS MJNJUBUJPOT
'JSTUMZ JOOPDBUFHPSZJTUIFEFQUIPGUIFSFTFDUJPOTTQFDJ¾FE4FDPOEMZ JO5CMFTJPOTUIF
BOUFSJPSDPNNJTTVSFJTOPUOFDFTTBSJMZJOWPMWFE4UFJOFSJTUIFPOMZBVUIPSUPNBLFUIJTEJT
UJODUJPO JO IJT EBUB 5IJSEMZ BT TUBUFE FBSMJFS UZQF 7 SFTFDUJPOT BSF B NJYUVSF PG FYUFOEFE
SFTFDUJPOT TVDI BT UIF BOUFSJPS DPNNNJTTVSF CVU BMTP UP UIF TVQSB BOE TVCHMPUUJT BOE JT
UIFSFGPSFQSBDUJDBMMZVTFMFTTGPSUIJTQVSQPTF
%FFQMFTJPOTSFRVJSJOHSFTFDUJPOPGUIFWPDBMJTNVTDMFBOEPSGBMTFWPDBMGPME
8IFOFWBMVBUJOHUIFMJUFSBUVSFGPSUIJTUZQFPGMFTJPOUIFGPMMPXJOHTUBHJOHDBUFHPSJFTBSFUIF
NPTUBQQMJDBCMF
5B"$
5BVOJMBUFSBM 5ZQF****7SFTFDUJPOT
5ZQF7SFTFDUJPOT TQFDJ¾DBMMZUZQF7D
%BUBJTTVNNBSJ[FEJOUBCMF"TBCPWF UIFTFDBUFHPSJFTIBWFMJNJUBUJPOT*O5BPS5BUVNPST
UIFEFQUIPGUIFSFTFDUJPOJTOPUTUBUFEBMUIPVHIJUJTNPSFMJLFMZUPIBWFCFFOEFFQFSJO5B
UVNPST5ZQF****7SFTFDUJPOTBSFBSFMBUJWFMZHPPESFQSFTFOUBUJWFPGUIJTDBUFHPSZ BMUIPVHIB
VOJMBUFSBMSFTFDUJPOJOUPUIFBOUFSJPSDPNNJTTVSFJTOPUFYDMVEFE"MTP TFWFSBMTUVEJFTQFS
GPSNUZQF***SFTFDUJPOTGPSTVQFS¾DJBMMFTJPOT SFOEFSJOHUIFDIBODFPGDVSBUJPOWFSZIJHIBUB
SFMBUJWFMZIJHIDPTUUPUIFWPJDF8JUIUZQF7SFTFDUJPOTBTSFQSFTFOUBUJWFGPS5UVNPSTPGUIF
WPDBMGPMET BHBJOUIFQSPCMFNJTUIFIFUFSPHFOFJUZPGUIFSFTFDUJPOTJOUIJTHSPVQ
5BCMF ] 0VUDPNFEBUBSFMFWBOUUPTVQFS¾DJBMMFTJPOTSFRVJSJOHCJMBUFSBMSFTFDUJPOBOEPSSFTFDUJPOPGUIF
BOUFSJPSDPNNJTTVSF
$BUFHPSZ "VUIPS / 0ODPMPHJDBMSFTVMUT
'VODUJPOBMSFTVMUT
-$ 5-
5B "$ 8PMGFOTCFSHFS
1SBEBIBO
;FJUFMT
4UFJOFS
5C (BMMP
4UFJOFS
.PUUB
5ZQF7 3PI
-FEEB
1FSFUUJ
1FSFUUJ
1FSFUUJ
(3#"4HSBEF TFWFSFEZTQIPOJB 7)*
(3#"4HSBEF NPEFSBUFEZTQIPOJB
(3#"4HSBEF NPEFSBUFEZTQIPOJB
5ZQF7B
-$ MPDBMDPOUSPM -1 MBSZOYQSFTFSWBUJPO "$ BOUFSJPSDPNNJTTVSF
BOUFSJPSDPNNJTTVSFJOWPMWFNFOUXBTOPUBTJHOJ¾DBOUGBDUPSJONVMUJWBSJBUFBOBMZTJT
JOWPMWFNFOUPGBOUFSJPSPGWPDBMDPSEJNQBDUFEPOMPDBMDPOUSPM Q
7B SFTFDUJPOPGQBSUPGUIFDPOUSBMBUFSBMWPDBMDPSE
5BCMF ] 0VUDPNFEBUBSFMFWBOUUPEFFQMFTJPOTSFRVJSJOHSFTFDUJPOPGUIFWPDBMJTNVTDMFBOEPSGBMTF
WPDBMDPSE
$BUFHPSZ "VUIPS / 0ODPMPHJDBMSFTVMUT
'VODUJPOBMSFTVMUT
-$ 5-
5B"$ 4UFJOFS F 5ZQF****7 3PI
,FOOFEZ
-FEEB
1FSFUUJ UZQF***
1FSFUUJ UZQF*7 1FSFUUJ
(3#"4HSBEF TFWFSFEZTQIPOJB 7)*
(3#"4HSBEF NPEFSBUFEZTQIPOJB (3#"4HSBEF NJMENPEFSBUFEZTQIPOJB
5B
VOJMBUFSBM
4UFJOFS
.PUUB
5ZQF7 3PI
-FEEB
1FSFUUJ
1FSFUUJ
1FSFUUJ
(3#"4 HSBEF TFWFSF EZTQIPOJB 7)*
(3#"4HSBEF NPEFSBUFEZTQIPOJB
(3#"4HSBEF NPEFSBUFEZTQIPOJB
5ZQF7D
7D SFTFDUJPOPGQBSUPGUIFTVQSBHMPUUJT
/#5ZQF *** SFTFDUJPOT TPNFUJNFT JT DBSDJOPNB JO TJUV TPNFUJNFT 5B NJYUVSF PG TNBMM BOE MBSHF UVNPST BOE TPNFUJNFT
UZQF7BTFBSMJFS
